JP2008504075A - Optical ophthalmic treatment method and apparatus - Google Patents

Abstract

  An optical scanning system and method for treating a trabecular mesh of a patient's eye includes a light source that produces alignment and treatment light, and alignment and treatment light alignment by deflecting the alignment and treatment light. And a scanning device for producing a therapeutic pattern and an ophthalmic lens assembly mounted on the patient's eye, the ophthalmic lens assembly having a light pattern on the trabecular mesh of the patient's eye A reflective optical element for reflecting; The reflective optical element may be a continuous annular mirror (eg, a smooth mirror or a mirror with multiple facets) that images the entire trabecular mesh or a reflective optical element that moves in concert with beam deflection. The alignment of the light on the eye and the visualization of the treatment pattern can be performed by its reflection from the visualization mirror, which transmits a part of the light emerging from the trabecular mesh.

Description

  The present invention relates generally to ophthalmic treatment of a patient's eye, and more particularly to photomedical treatment at multiple locations on a trabecular mesh of the patient's eye.

  In addition, this application is a claim application of US Provisional Patent Application No. 60 / 583,436, filed on June 28, 2004.

  Glaucoma is a potentially debilitating group of eye diseases, each of which is well known to have a high risk of blindness. These conditions include, but are not limited to, open-angle glaucoma, desquamation glaucoma, and pigmented glaucoma. Common to all of these glaucoma conditions is that the trabecular mesh (TM) cannot balance the generation from the aqueous humor from the ciliary body and its removal, thereby reducing intraocular pressure ( IOP) becomes higher. Ocular hypertension associated with glaucoma causes a gradual degeneration of the cells that make up the optic nerve. As the optic nerve dies, vision decreases slowly. Visual loss is often not noticed until significant nerve damage has occurred.

  Visual loss due to glaucoma is irreversible. Recent morbidity figures for glaucoma from the National Institutes of Health and the World Health Organization are surprisingly high. Glaucoma is the second leading cause of blindness in the United States and the first leading cause of preventable blindness. More than 3 million Americans have glaucoma, but only half of these people know themselves, and most people are suffering from a condition called open-angle glaucoma Presumed. About 120,000 of these people are blind due to glaucoma, accounting for 9% to 12% of all cases of blindness. With glaucoma, more than 7 million people visit American doctors every year. In terms of social security benefits, lower income tax revenues, and health care spending, the annual cost borne solely by the US government is estimated to be over $ 1.5 billion. The worldwide number of suspected cases of glaucoma is about 65 million. Although glaucoma cannot be prevented by itself, it may be avoided if the disease is discovered and treated early.

  Today, there are various treatment options for the treatment of glaucoma. Invasive surgical intervention is usually used as a last resort. The first line of treatment is to use drugs to lower IOP. Of course, there is no panacea. In fact, drugs are useless for many patients. The overwhelming majority of these open-angle glaucoma cases are currently being addressed by laser therapy, such as argon laser trabeculoplasty (ALT) or selective laser trabeculoplasty (SLT). Both ALT and SLT procedures require approximately 100 laser spots that are equally spaced per 180 degrees of the patient trabecular mesh (TM). The spot diameters of ALT and SLT are typically 50 μm and 400 μm, respectively. ALT treatment typically only requires a 180 degree patient trabecular mesh (TM), and SLT is applied to the entire perimeter for a total of 200 spots. Both of these treatments are tedious and time consuming for physicians and patients. This is because the laser treatment spot is applied manually and continuously. However, the main difference between SLT and ALT is the pulse duration of the therapeutic light. SLT substantially spatially limits the heat generated using short pulses to the target melanin particles, which is why SLT is considered a “selective” or “subthreshold” treatment, In contrast, ALT uses longer pulses to cause damage to TM itself, which is called standard or “coagulant” treatment. Both ALT and SLT treat TM with light that is primarily absorbed by the melanin present therein.

  The light absorption spectra of melanin, oxyhemoglobin (HbO2) and deoxyhemoglobin (Hb), the main intraocular chromophore, are shown in FIG. The anatomical structure of this eye is shown in FIG. 2, which comprises the cornea 1, the iris 2, the anterior chamber 3, the pupil 4, the lens 5, the pattern 6, the trabecular mesh TM7, the conjunctiva 8, It has a sclera 9 and an eye corner 10. The fluid flow is indicated by arrows in FIG. As can be seen from this figure, TM optical therapy requires light to be incident at a very shallow incidence angle on the eye.

  US Pat. No. 5,549,596 issued to Latina (hereinafter sometimes referred to as “Latina patent”) discloses a method for selectively damaging intraocular pigmented cells. The method uses laser irradiation while preserving non-pigmented cells and collagenous structures in the irradiated area. This method is useful for the treatment of glaucoma (SLT), intraocular melanoma and macular edema. This patent document discloses a basic selective therapy using a pulsed laser. However, the delivery of such individual pulses is lengthy and time consuming.

  US Pat. Nos. 6,059,772 and 6,514,241 issued to Hsia et al. Describe a wavelength of 350-1300 nm, energy of 10-500 mj and pulse duration. Disclosed is a non-invasive device and method for treating open-angle glaucoma in the human eye by cauterizing the target area of the TM with the action of heat using pulsed radiation for a time of 0.1-50 μs. In this case, a pulse slightly longer than the pulse used in SLT is used. However, these patents do not address the long and time-consuming drawback of delivering individual pulses.

  US Pat. No. 6,682,523 issued to Shaduck (hereinafter sometimes referred to as the “Shadak patent”) treats a trabecular mesh of a patient non-invasively to treat glaucoma. A system is disclosed. This system and technology provides an exogenous chromophore with energy applied directly to the media located in the enclosed space within the patient's TM, and a micro-implantable body (nanocrystalline particle) located in the deep region of the TM The amount of outflow of aqueous humor is increased by laser irradiation. This results in thermoelastically induced microcavity, which helps to cauterize debris and deposits therein. This scheme is the same as that of the Latina patent in that it requires the use of short pulses and therefore should be considered a “selective” treatment. However, unlike the Latina patent, this scheme utilizes an exogenous chromophore. The choice of wavelength for the therapeutic light source is no longer dependent on the absorption by melanin, but instead is primarily related to the absorption of this exogenous chromophore. However, the Shadak patent also does not address the long and time-consuming drawback of delivering individual pulses.

  3-5 show an increasingly complex configuration of the currently available corner lens assembly 12 used to approach the TM. Such lens assemblies currently require that light be redirected into the eye at a very shallow angle of incidence so that the light reaches the TM. In addition to one or more focusing lenses, these lens assemblies 12 all have a mirror 14 for redirecting light into the eye at a shallow angle of incidence. 3 shows a single mirror design example, FIG. 4 shows a two mirror design example, and FIG. 5 shows a four mirror design example. In each case, the mirror used is a plane mirror. Many mirrors are discontinuous and spaced from each other, thus creating a gap in the field of view. Thus, these corner lenses must be moved during the procedure to fill the gaps created by the discontinuous mirrors and to access the portion of the TM located outside the relatively narrow field of view.

  Accordingly, there is a need for a simple and flexible treatment for multiple locations of a patient's trabecular mesh.

US Pat. No. 5,549,596 US Pat. No. 6,059,772 US Pat. No. 6,514,241 US Pat. No. 6,682,523

  The present invention solves the above-mentioned problems by providing an optical scanning system for treating a target tissue of a patient's eye. The system includes a light source that produces a beam of light, a scanning device that deflects the light beam to produce a pattern of light beam, and a contact surface that contacts the patient and a reflection that reflects the light beam pattern onto the target tissue of the eye. An ophthalmic lens assembly including an optical element.

  In another aspect of the invention, an optical scanning system for treating a trabecular mesh of a patient's eye includes a light source that produces a beam of light and a scanning device that deflects the light beam to produce a light beam pattern. And an ophthalmic lens assembly attachable to the patient's eye, the ophthalmic lens assembly including reflective optical elements that reflect the light pattern onto the trabecular mesh of the patient's eye.

  In yet another aspect of the present invention, a method of treating a trabecular mesh of a patient's eye includes attaching an ophthalmic lens assembly that includes reflective optical elements to the patient's eye, and a beam of light. Generating, deflecting the light beam to generate a pattern of the light beam, and reflecting the light pattern with a reflective optical element to strike the trabecular mesh of the patient's eye.

  Other objects and advantages of the invention will become apparent upon review of the specification, claims and appended drawings.

Detailed Description of Preferred Embodiments
The present invention provides both an instrument and method for treating a trabecular meshwork (TM) of a patient's eye using a scanning optical system. FIG. 6 is a flowchart of the method of the present invention. In step 1, the visible alignment pattern is projected onto the TM. This alignment pattern is coincident with the portion of the eye that is subsequently illuminated with therapeutic light so that the system is correctly aligned with the target portion of the TM. In step 2, the user may manually adjust the alignment pattern. This step is optional depending on the accuracy of the original projection image. Such adjustment involves adjusting the size, scale, shape, rotation, curvature, ellipticity, etc. of the spot that forms the pattern to match the requirements of the pattern and / or the particular patient contact lens used. Is good. In step 3, the start of the treatment procedure is triggered by the operator, for example by pressing a foot switch or finger switch or the like. The fourth step is to automatically deliver the light therapeutic pattern substantially aligned with the light alignment pattern (in response to the operator action of step 3) to the TM. The therapeutic light may be for diagnostic and / or therapeutic purposes.

  The alignment and treatment pattern may consist of a single spot of light, multiple spots of light, a continuous pattern of light, multiple continuous patterns of light and / or any combination thereof. Good. In addition, the alignment pattern need not be the same as the treatment pattern, and preferably at least to deliver the treatment light only within the desired target area for patient safety. Define the boundaries. This may be done, for example, by creating a contour of the intended treatment pattern in the alignment pattern. Thus, the spatial extent of the treatment pattern should be known to the user, even if it is not the exact location of the individual spots themselves, thus scanning is optimal with respect to speed, efficiency and accuracy. It becomes. The alignment pattern may also be perceived as flickering to further improve its visibility to the user.

  The method and apparatus of the present invention may utilize either or both of continuous wave (CW) and pulsed light sources for standard, selective and / or subthreshold treatments. The selective treatment preferential light absorption and subsequent heating characteristics improve the risk of causing damage to tissue and / or structures located adjacent to the trabecular mesh. Thus, such selective treatment allows irradiation of adjacent tissues and / or structures without the risk of causing considerable incidental damage. With that in mind, the alignment and treatment pattern can include adjacent tissue and / or structure and can be placed closer to the trabecular mesh during such selective treatment. To avoid complications, the apparatus and method of the present invention will be described with respect to the trabecular mesh that is the target tissue, but it is understood that adjacent tissue and / or other tissue is included during such selective treatment. It should be.

  Preferably, the therapeutic pattern is completed in approximately less than a second, as is a typical reliable patient fixation time. Long exposure times increase the risk of inadvertent movement of the patient's eyes. Thus, once the system is aligned with the target tissue, it is preferable to complete the treatment with a single action of the operator. The present invention can reduce the treatment time for laser trabeculoplasty by projecting a pattern of therapeutic light that can treat most if not all of the TM with a single system exposure. With the therapeutic pattern delivered in less than about 1 second, the eye can be considered to be stationary and thus the present invention increases patient comfort and treatment time throughout standard laser trabeculoplasty. Can be reduced.

  The alignment and treatment pattern is preferably formed as a pattern P of light spots S projected onto the target tissue, as shown in FIGS. 7A-7D. Such a pattern can be tailored to the tissue to be treated and / or delivery optics (eg, a particular corner lens assembly used to deliver alignment and treatment light). Spot S is shown as a circle, but this need not be the case. The spot S most likely has a characteristic intensity profile that is characteristic of the light source, such as a Gaussian or top-hat distribution, but this need not be the case. Preferably, all spots S are delivered during a single exposure of the system in alignment or therapeutic pattern. For example, with a pulsed light source, the entire pattern P is sent out with a single system exposure activated by the user, and each light source pulse produces a separate spot S.

  Current therapeutic pulses utilize pulse durations on the order of nanoseconds to microseconds. Thus, assuming that the spot S does not move during the pulse or that these pulse durations are short, the scanning operation may be minimal (ie, the scanner that forms the pattern P will emit light). It should be made to move continuously while pulsing, and this scanner still does not compromise the treatment). Of course, other pulse durations are possible. If the pulse duration is long enough to cause significant undesired movement during delivery of the spot S, the scanner may be configured to stay in place during irradiation. Thus, it is preferable to make a one-dimensional or two-dimensional pattern P as shown in FIGS. Pattern P need not form a regular array of spots S as shown in FIG. 7D. When used in a corner lens assembly consisting of multiple mirrors, the number of patterns P produced should match the number and position of corner lens mirrors. The angular spatial extent of the spot S and pattern P may be limited by the details of the corner lens assembly used. Specifically, the corner mirror may ultimately determine the achievable spread of the pattern P and its elements.

  FIGS. 8A-8D are ideal for continuous wave (CW) light sources, using one or more spots S to draw or form elongated straight or curved line segments. It shows whether a typical pattern P can be formed. For example, in FIG. 8A, the spot S is scanned at a speed V to form a line segment scan LS of the pattern P. Each line segment LS ends when the light source no longer delivers light to the spot S being scanned forming the line segment LS. This can be done in many ways, such as by using an aperture by using a shutter placed in the light path by directly gating on and off the light source. As shown in FIG. 8B, the pattern P is preferably formed by a plurality of line segments LS and / or spots S. The line segment LS may be shaped or bent as shown in FIG. 8C, or it may be bent and shaped to form a geometric object or symbol as shown in FIG. 8D (this line segment Are particularly suitable as contours of the target tissue for alignment patterns as described above).

  Thus, for the purposes of the present disclosure, the “pattern” of light is not completely overlapping (or not overlapping at all) at least two spots S or in a single pulse or with CW light It shall mean one or more spots that move, resulting in a projected straight or curved line segment.

  As described in detail below, given a continuous corner mirror, it is possible to send a single continuous scan to illuminate 360 degrees around the TM. Note that knowing the size, orientation and energy distribution of the basic spot S allows you to specify a specific dosimetry by adjusting the scanning speed V as well as the optical power or spot size. is important. In this way, the light should be made to stagnate on one point of the trabecular mesh TM for a specified period of time, thus allowing a specific amount of energy to be delivered to that point. Thus, the stagnation time can be considered as the “pulse duration” of the CW light. With that in mind, an example using a round spot S with a pulse duration of 1 μs and a diameter of 100 μm requires a scanning speed of 100 μm / μs at or around the target area. Knowing that the trabecular mesh TM has an average diameter of approximately 20 mm, this means that the entire inner circumference of the trabecular mesh TM can be scanned in only 300 μs.

  FIG. 9 is a schematic diagram of a system suitable for performing the method of FIG. The alignment light is produced using an alignment light source 20 that may be controlled by control electronics 22 via an input / output device 24. Similarly, therapeutic light may be produced using the therapeutic light source 26. The light sources 20, 26 may be any gas or solid state laser device or light emitting diode. The light sources 20, 26 are preferably separate devices since they typically produce light at different wavelengths and power levels, but the light sources can be aligned and treated with different or identical wavelengths. You may combine with the state of the single light source to produce. The alignment light from the source 20 is preferably visible (however, the alignment light may not be visible to the eye when using another visualization scheme, such as infrared imaging). The therapeutic light from source 26 is also visible, but need not be. As can be seen in FIG. 1, the light absorption range of the target chromophore and melanin is very wide. In addition, because the target chromophore is exogenous, its absorption characteristics primarily determine the wavelength options for the therapeutic light source 26. If the treatment light source 26 produces visible light, the treatment light source can also be used to produce an alignment pattern instead of the alignment light source 20 (eg, an eye safety filter is in the visualization path). If not, simply reduce its output power during system alignment). Similarly, if the therapeutic light source 26 produces invisible light, the therapeutic light source can be used for alignment in a manner similar to non-visible imaging schemes (eg, infrared cameras, scanning lasers). By using an ophthalmoscope, etc.).

  The light output from the therapeutic light source 26 first strikes a mirror 30, which reflects a portion of the therapeutic light to the photodiode 32 and measures its power for safety purposes. Next, the therapeutic light strikes the shutter 34, the mirror 36 and the mirror 38. The shutter 34 basically serves to control the amount of therapeutic light delivered, and this shutter is used to quickly gate and / or generally block the therapeutic light. Is good. The mirror 36 is an optional rotating mirror, and the mirror 38 is used to combine the treatment light and the alignment light from the light source 20 to form an alignment and treatment light beam 46, where The alignment light from the source 20 may be adjusted so that it coincides downstream with the treatment light. It should be noted that the alignment light and the treatment light need not be made simultaneously, in which case the mirror 36 actually combines the beam paths for these two light beams (ie, position The alignment / therapeutic light 46 includes only alignment light at certain times and only therapeutic light at other times). A mirror 40 is used to reflect a portion of the alignment and treatment light and direct it to the photodiode 42 for additional measurements (and to ensure complete monitoring of the state of the shutter 34). .

  A lens 44 may be used to condition the alignment and treatment light 46 prior to its incidence on the scanner assembly 48. The lens 44 may be a single lens or a compound lens. If the lens 44 is a compound lens, it may be configured as a zoom lens assembly that adjusts the size of the spot S and thus the size of the pattern P. Another lens 50 may be placed one focal distance away from the optical midpoint of the scanner assembly 48 to produce a telecentric scan (however, this is optional). For systems that include lens 50, telecentric scanning helps to maximize scanning speed as long as the remaining optical elements are large enough to accommodate the entire scan. Most of the ophthalmic contact lenses currently available require a telecentric input.

  The light 46 then strikes the mirror 52, which reflects the light toward the target. The mirror 52 is a highly reflective film whose spectrum matches the output of the alignment and treatment light and allows the visualization of the target area through the mirror 52 through the visualization light coming from the target including. Preferably, the transmitted light that has passed through the mirror 52 is configured to balance the white, and in this case, the film produces a more natural color without producing a pinkish result when using a green notch filter film. To be visible. The lens 50 is further used to image the optical midpoint of the scanner assembly 48 onto the mirror 52 in order to minimize the size of the mirror 52 in an attempt to increase the overall solid angle spanned by the visualization device. Is good. If the mirror 52 is small, it should be placed directly in the visualization path without causing much interference. The mirror 52 may also be placed in the center of a binocular imaging device, for example a Zeiss slit lamp biomicroscope, without disturbing the visualization. Visualization is accomplished by looking directly at the retina through mirror 52 or by creating a video image from light that has passed through mirror 52 to be displayed on a remote monitor or graphical user interface 54 as shown in FIG. it can.

  The scanning assembly 48 preferably has two optical elements 56, 58 (eg, mirrors, lenses, diffractive optics, rotating wedges, etc.) that deflect (deflect) the light beam 46 and finally The light beam can be individually tilted or moved perpendicularly to each other to direct the light beam toward the trabecular mesh TM, and the light beam forms a pattern P on it at the trabecular mesh. Will finally be located. For example, the optical elements 56, 58 may be galvanometers, solenoids, piezoelectric actuators, motors, servo motors or mirrors attached to other types of actuators that deflect the beam 46 by tilting the mirror. Of course, a single element two-dimensional scanner such as an acousto-optic deflector, an optical phased array or a micromirror device may be further used. Alternatively, the mirror may have optical power (eg, may have a surface curvature), in which case deflecting the beam can be achieved by translating the mirror. Alternatively, the optical elements 56, 58 may be lenses, which deflect the beam by the translational movement of the lens. Other methods of scanning the light beam 48 without using the scanner assembly 48 include moving the light sources 20, 34 themselves directly and using a single movable optical element (including the movable mirror 52). If the optical elements 56, 58 have optical power, an image on the trabecular mesh TM may be created by adding a compensating optical element (not shown) as opposed to simple illumination.

  The light beam 46 scanned by the scanner device 48 and reflected by the mirror 52 is focused on the trabecular mesh by the ophthalmic lens assembly 60, and the ophthalmic lens assembly reflects the light 46. It has a corner mirror 62 that enters the eye at a very shallow angle. The ophthalmic lens assembly may further include one or more lenses that are directly attached to the eye, such as the contact lens 61. In order to obtain good positioning, the ophthalmic lens assembly 60 contacts the patient and holds the assembly 60 in a stable state with respect to the patient, particularly with respect to the patient's eyes (eg, contact lens 61). Surface, nose bridge surface, forehead surface, etc.). Ophthalmic lens assemblies having one, two or four corner mirrors are well known and do not result in an unbroken view of TM. Accordingly, the corner mirror 62 is preferably continuous as will be described in greater detail below in connection with FIGS.

  The position and characteristics of the pattern P can be further controlled using a joystick or other input device 64 similar thereto. The pattern P can also be rotationally aligned with the corner mirror 62 by simply rotating the ophthalmic lens assembly 60. The final placement of the pattern P is only limited by the optics of the system and, of course, the patient's personal characteristics that may disturb this placement. The ophthalmic lens assembly 60 may be a contact or non-contact assembly (eg, with optical elements that touch or do not touch the patient's eyes).

  The light source 20 is commanded from the control electronics 22 by the input and output device 24 to produce separate spots, or simply to make a continuous scan as a means of running the CW to produce the pattern P of alignment light. Is preferably gated on and off. The electronics 22 similarly controls the position of the scanning optics 56, 58, and thus ultimately the therapeutic light pattern P as described above with reference to FIGS. 7A-7D and 8A-8D. Control the position of the. Thus, the pattern P or any of its elements may be made to be perceived by the user as blinking. Furthermore, the perception of both separate spots and blinks can be achieved simply by quickly scanning between elements of the pattern P to limit the amount of light combined by the user in these intermediate spaces.

  As disclosed, the present invention is suitable for use with pulsed or CW light sources. Similarly, due to its inherent flexibility, CW light sources can be used in fields where only pulsed light sources are currently used, such as ALT and SLT. This limits the dwell time of the scanning light onto the target tissue, and so does so that the tissue can receive a “pulse” of light even though the source itself is not actually pulsed. Become. By adjusting the size of the spot S, the scanning speed V and hence the stagnation time on the tissue, a finite range of exposure possibilities limited only by the speed of the scanning element is taken into account.

  FIG. 10 is a schematic diagram of a modified embodiment of the system of FIG. 9 with an optical fiber delivery scheme. In this embodiment, lens 70 is used to direct alignment and treatment light 46 into optical fiber 72. Light 46 exiting optical fiber 72 strikes lenses 74 and 76 that can condition the light and serve as a zoom system before the light enters scanner assembly 48. An image of the output face of the optical fiber 72 should be relayed to the target area, and a “flat-top” intensity profile should be used rather than a typical Gaussian distribution. The rest of the system of FIG. 10 is the same as the system shown in FIG.

  FIGS. 11 and 12 show an ophthalmic lens assembly 80 that is optimized to scan the alignment and treatment pattern over the TM. Lens assembly 80 may include one or more lenses, such as lens 81, that focus light 46 into the eye. The lens assembly 80 looks at the entire perimeter of the trabecular mesh TM, thus a continuous annular interior corner that allows a single complete treatment of the entire TM without having to move or reposition the lens assembly 80. A corner mirror 82 is further provided. The continuous annular mirror may be a single continuous annular mirror (ie, FIG. 12) or a mirror formed of a plurality of facets 84 that face each other so that there are no tears or gaps around the entire periphery of the mirror. (That is, FIG. 11). Thus, there may be slight discontinuities in the image caused by the mirror facet joints, but since the light is scanned around the corner mirror 82 there is no gap where light is lost. . In this way, a full 360 degree scan of the trabecular mesh TM can be performed, and this scan is more complete and uniform than can be obtained with current corner lenses with separate mirror faces. . The number of facet mirror mirrors should be selected to allow a substantially homogeneous treatment throughout such a complete scan. A continuous multi-faceted corner mirror 82 is shown in FIG. 11, which has ten flat facets 84 that face each other. A continuous circularly symmetric internal corner mirror 82 is shown in FIG. Such mirrors may be frustoconical as shown. Although the symmetry eliminates the need to match the angular and spatial spread of the scanner output to produce a uniform scan, such a corner mirror 80 is anamorphic that cancels out of focus asymmetry. Optical compensation may be required. For this purpose, the optical components of the ophthalmic lens assembly 80 may be made to incorporate a spherical cylindrical or donut-shaped focusing scheme to counteract the effects of the corner mirror 82. It is possible to direct (continuously) the light 46 into the eye using other optical elements than the mirror 82, for example diffractive or refractive optical components such as prisms, diffraction gratings, etc. It should be noted. Similarly, an aspheric optical element, rather than a contact lens, is added to the scanner assembly itself, and the position of the scanning light is generated to produce the desired optical homogeneity, as will be described in detail below. It is good to be comprised so that it may rotate in cooperation with.

  The scanning system used in conjunction with the lens assembly of FIGS. 11 and 12 is an off-salmic lens with angular and spatial spreads to produce a scan with overall uniformity in the trabecular mesh TM. It may be configured to provide alignment and / or therapeutic light scanning that matches the particular optical system of assembly 80. For example, the scanning by the scanning assembly 48 may be adjusted to compensate for the number, location and angular orientation of multiple mirror facets 84 to produce a uniform scan of TM from these mirror facets 84. . Such a scan is preferably pre-programmed into control electronics 22 and / or adjusted by the user so that once the system is aligned with the TM and the user triggers a therapy scan, the automated therapy is performed. It is good to make it.

  FIG. 13 is a schematic diagram of another embodiment that is substantially the same as the embodiment shown in FIG. 9 with the addition of a rotating anamorphic optical element 86. In this embodiment, the anamorphic optical element 86 is used to compensate for the cylindrical focus of the ophthalmic lens assembly as shown in FIG. The control electronics 22 coordinates the position of the scanning mirrors 56, 58 and the rotation of the anamorphic optical element 86 to ultimately produce a scan with the desired optical homogeneity located at the trabecular mesh TM. Let Anamorphic compensation can be provided in various ways. The anamorphic optical element 86 may be, for example, a cylindrical lens (single element lens or multi-element lens). Such a lens need not be a single element lens, but may be a multi-element lens. The multi-element lens compensates well for chromatic aberration that can cause a difference between the alignment light and the treatment light when the light output of the alignment light and the treatment light are at different wavelengths. Can help to. However, this is obtained at the cost of increasing the size and mass of the compensating anamorphic optical element 86, which increases its moment of inertia and makes it difficult to accelerate quickly. A lens may be used as the anamorphic optical element 86 to eliminate such design complexity. Further, the anamorphic optical element 86 may be an adaptive optical system that does not require rotation. Alternatively, the anamorphic optical element may be reconfigured to produce the desired effect.

  FIG. 14 illustrates how to improve the problem of accelerating the anamorphic optical element 86 described above. In this case, the lateral dimension of the anamorphic optical element 86 is minimized so that it corresponds exactly to the output of the scanner assembly 48. The anamorphic optical system 86 is then placed in the eccentric mount 88 so that the anamorphic optical system captures the light 46 as the eccentric mount 88 rotates in coordination with the scan. The optical axis 90 of the anamorphic optical system 86 is aligned substantially perpendicular to the radius R of the eccentric mount 88 to complement the optical effects of the ophthalmic lens assembly described above. This assembly now has a significantly reduced moment of inertia compared to the form of the anamorphic optical element 86 composed primarily of optical elements, so that it can be accelerated more easily. A morphic optical element 86 is formed. In this manner, a substantially uniform spot can be generated at an arbitrary position in the trabecular mesh TM. As a result, this allows uniform scanning of both the pulsed light source and the CW light source. In the case of a CW light source, as described above with reference to FIGS. 8A to 8D, the scanning speed may be controlled so as to allow adjustment of the light stagnation time and the accumulated energy accumulation amount.

  FIG. 15 is substantially the same as the embodiment described above with reference to FIG. 9 except that instead of the scanning mirrors 56 and 58 of the scanning assembly 48, an additional adaptive optical element 92 for scanning the light 46 is added. 1 is a schematic diagram of an embodiment. In this embodiment, the adaptive optical element 92 may be reconfigured to form a complex optical system. For example, both a scan and any anamorphic corrections considered to be scans may be configured for the light 46 with this single element. Some examples of such optical elements 92 include deformable mirrors, deformable lenses, and optical phased arrays.

  FIG. 16 illustrates another feature of the present invention in which an additional internal mirror 94 is added to the lens assembly 80 of FIG. The inner mirror 94 works in cooperation with the corner mirror 82 to produce an upright image of the trabecular mesh TM. Both inner mirror 94 and corner 82 may independently include a single facet or multiple facets, or a single continuous element, as described with reference to FIGS. .

  FIG. 17 shows another embodiment of the present invention in which the corner mirror 62 in the contact lens is configured to rotate in conjunction with the scanner output to allow full 360 degree treatment of TM without complicating anamorphic correction. It shows the characteristics. The angle mirror 62 is mounted on the inner surface of the lens assembly housing and is configured to rotate about the optical axis of the lens in a manner that maintains a constant angle between the mirror face and the optical axis of the incoming beam. It is good. This can be done in a wide variety of ways, such as by using a small motor and external contact spur gear assembly to directly rotate the mirror housing or by using a rack and pinion with a helical cam and follower structure. Furthermore, the use of a rotary encoder that monitors the position of the lens allows its safe use in a closed loop feedback system.

  It is to be understood that the invention is not limited to the embodiments described and illustrated above, but includes any and all variations that fall within the scope of the invention as set forth in the claims. For example, the scanning method and apparatus of the present invention can be applied to eye tissues other than TM. In addition, the treatment pattern and the light source can be omitted if the treatment pattern can be manually aimed at by using other optical elements provided in the optical path.

It is a graph which shows the light absorption spectrum of main eye chromophore, ie, melanin, oxyhemoglobin (HbO2), and deoxyhemoglobin (Hb). 1 is a cross-sectional side view of an anterior chamber anatomy of a human eye including a trabecular mesh (TM). FIG. 1 is a cross-sectional side view of a prior art corner lens assembly. FIG. 1 is a cross-sectional side view of a prior art corner lens assembly. FIG. 1 is a cross-sectional side view of a prior art corner lens assembly. FIG. 3 is a flowchart of the method of the present invention. FIG. 6 shows an exemplary scan pattern used for a pulsed or gated light source. FIG. 6 shows an exemplary scan pattern used for a pulsed or gated light source. FIG. 6 shows an exemplary scan pattern used for a pulsed or gated light source. FIG. 6 shows an exemplary scan pattern used for a pulsed or gated light source. FIG. 3 is a diagram illustrating an exemplary scan pattern used for a continuous wave (CW) light source. FIG. 3 is a diagram illustrating an exemplary scan pattern used for a continuous wave (CW) light source. FIG. 3 is a diagram illustrating an exemplary scan pattern used for a continuous wave (CW) light source. FIG. 3 is a diagram illustrating an exemplary scan pattern used for a continuous wave (CW) light source. 1 is a schematic diagram illustrating the light generation and scanner assembly of the present invention. 1 is a schematic diagram illustrating the light generation and scanner assembly of the present invention utilizing fiber optic delivery. 1 is a cross-sectional side view of a corner lens assembly of the present invention optimized for scanning therapy. FIG. FIG. 6 is a cross-sectional side view of an alternate embodiment of the inventive corner lens assembly optimized for scanning therapy. 2 is a schematic diagram illustrating an alternative embodiment of the light generation and scanner assembly of the present invention. FIG. 3 is a plan view of an anamorphic optical element attached to an eccentric mount of the present invention. 6 is a schematic diagram illustrating another alternative embodiment of the light generation and scanner assembly of the present invention. FIG. 6 is a cross-sectional side view of another alternate embodiment of the inventive corner lens assembly optimized for scanning therapy. 6 is a schematic diagram illustrating yet another alternative embodiment of the light generation and scanner assembly of the present invention.

Claims (48)

An optical scanning system for treating a target tissue of a patient's eye,
A light source that produces a beam of light;
A scanning device for deflecting the light beam to produce a pattern of the light beam;
An optical scanning system comprising a contact surface that contacts a patient and an ophthalmic lens assembly that includes reflective optical elements that reflect the light beam pattern onto a target tissue of the eye. Light exits the target tissue of the eye, and the system
The light beam pattern is reflected from the scanning device to the ophthalmic lens assembly, transmits a part of the light emitted from the target tissue of the eye, and transmits the light beam pattern on the target tissue of the eye. The optical scanning system of claim 1, further comprising a second optical element that enables visualization.   The optical scanning system of claim 1, wherein the light beam pattern includes at least two spots that do not completely overlap each other.   The optical scanning system of claim 3, wherein the light source includes a pulsed light source component.   The optical scanning system of claim 1, wherein the light beam pattern includes line segments.   The optical scanning system of claim 5, wherein the light source comprises a continuous wave light source component.   The optical scanning system of claim 1, further comprising a controller that controls the scanning device to produce the light beam pattern in response to a user command from an input device.   The optical scanning system of claim 1, wherein the reflective optical element comprises a plurality of mirror facets abutted together to form a continuous annular mirror, and the light beam pattern is reflected by the mirror facets.   The reflective optical element comprises a continuously formed annular mirror that provides a continuous 360 degree view of the target tissue of the eye, and the light beam pattern is reflected by the annular mirror. Optical scanning system.   The optical scanning system of claim 1, wherein the light source produces alignment light and treatment light in the light beam.   The light source includes a first light generation device that generates the alignment light and a second light generation device that is separate from the first light generation device and generates the treatment light. The optical scanning system of claim 10.   The optical scanning system according to claim 10, wherein the beam light pattern includes an alignment pattern for the alignment light and a treatment pattern for the treatment light.   The optical scanning system of claim 12, wherein the alignment pattern provides a visual indication of the location of the treatment pattern on the target tissue of the eye.   The optical scanning system according to claim 12, wherein the alignment light is visible light, and the therapeutic light is invisible light.   The optical scanning system according to claim 12, wherein the alignment light has a power lower than that of the treatment light.   The optical scanning system of claim 1, wherein the target tissue of the eye is a trabecular mesh of the patient's eye, and the reflective optical element is a corner mirror provided within the ophthalmic lens assembly.   The optical scanning system of claim 1, wherein the scanning device comprises at least one movable optical element that deflects the light beam.   The optical scanning system of claim 1, further comprising a controller that controls the scanning device and the reflective optical element such that the reflective optical element moves in concert with the deflection of the light beam. An optical scanning system for treating a trabecular mesh of a patient's eye,
A light source that produces a beam of light;
A scanning device for deflecting the light beam to produce a pattern of the light beam;
An ophthalmic lens assembly attachable to a patient's eye, the ophthalmic lens assembly including reflective optical elements that reflect the light pattern onto the trabecular mesh of the patient's eye; Optical scanning system.   The optical scanning system of claim 19, further comprising a controller that controls the scanning device and the reflective optical element such that the reflective optical element moves in concert with the deflection of the light beam.   The optical scanning system of claim 19, further comprising a controller that controls the scanning device to produce the light beam pattern in response to a user command from an input device.   The optical scanning system of claim 19, wherein the light beam pattern includes at least two spots that do not completely overlap each other.   The optical scanning system of claim 22, wherein the light source includes a pulsed light source component.   The optical scanning system of claim 1, wherein the light beam pattern includes line segments.   25. The optical scanning system of claim 24, wherein the light source includes a continuous wave light source component.   20. The optical scanning system of claim 19, wherein the reflective optical element comprises a plurality of mirror facets that are abutted together to form a continuous annular mirror.   20. The optical scanning system of claim 19, wherein the reflective optical element comprises a continuously formed annular mirror that provides a continuous 360 degree view of the trabecular mesh of the patient's eye.   The optical scanning system of claim 19, wherein the light source produces alignment light and treatment light in the light beam.   The light source includes a first light generation device that generates the alignment light and a second light generation device that is separate from the first light generation device and generates the treatment light. 30. The optical scanning system of claim 28.   29. The optical scanning system according to claim 28, wherein the beam light pattern includes an alignment pattern for the alignment light and a treatment pattern for the treatment light.   31. The optical scanning system of claim 30, wherein the alignment pattern provides a visual indication of the location of the treatment pattern on a trabecular mesh of the patient's eye.   30. The optical scanning system of claim 28, wherein the alignment light is visible light and the therapeutic light is invisible light.   30. The optical scanning system of claim 28, wherein the alignment light has a power that is lower than a power of the treatment light.   The optical scanning system of claim 19, wherein the scanning device comprises at least one movable optical element that deflects the light beam. A method for treating a trabecular mesh of a patient's eye,
Attaching an ophthalmic lens assembly including reflective optical elements to the patient's eye;
Generating a beam of light;
Deflecting the light beam to produce a pattern of the light beam;
Reflecting the light pattern with the reflective optical element and striking the trabecular mesh of the patient's eye.   36. The method of claim 35, further comprising moving the reflective optical element in concert with the deflection of the light beam.   36. The method of claim 35, wherein the deflection of the light beam is performed such that the light beam pattern includes at least two spots that do not completely overlap each other.   38. The method of claim 37, wherein the step of generating the light beam comprises generating pulsed light in the light beam.   36. The method of claim 35, wherein the step of deflecting the light beam is performed such that the light beam includes line segments.   40. The method of claim 39, wherein generating the light beam comprises generating continuous wave light in the light beam.   36. The method of claim 35, wherein the reflective optical element comprises a plurality of mirror facets that are abutted together to form a continuous annular mirror.   36. The method of claim 35, wherein the reflective optical element comprises a continuously formed annular mirror that provides a continuous 360 degree view of the trabecular mesh of the patient's eye.   36. The method of claim 35, wherein the step of generating the light beam includes generating alignment light and therapeutic light in the light beam.   44. The method of claim 43, wherein the beam light pattern includes an alignment pattern for the alignment light and a treatment pattern for the treatment light.   The method further comprises the step of visually recognizing the alignment pattern on the trabecular mesh of the patient's eye, wherein the alignment pattern is a location of the treatment pattern on the trabecular mesh of the patient's eye. 45. The method of claim 44, wherein the method provides a visual display.   45. The method of claim 44, wherein the alignment light is visible light and the therapeutic light is invisible light.   45. The method of claim 44, wherein the alignment light has a lower power than the therapeutic light. Using a controller to control a scanning device to cause the deflection of the light beam;
36. Activating an input device of the controller, wherein the controller causes the scanning device to deflect the light beam to produce the light pattern in response to actuation of the input device. The method described.

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